This picture shows the global distribution of HIV as of the end of 2002. An estimated 42 million persons are infected with HIV worldwide. Unfortunately, like most other scourges and infectious diseases, the burden of the disease is the highest in countries and regions most ill equipped and least resourceful to combat it. The most resource poor countries of sub-Saharan Africa and South and SE Asia are the worst hit areas.

In 2002 alone, the number of new HIV infections was a staggering 5 million. Again, the preponderance of these infections was in sub-saharan Africa followed by south and SE Asia.

If you look at the death numbers, the geographic distribution is similar to the incidence and prevalence of HIV and AIDS. In 2002 over 3 million persons died from AIDS displacing TB as the number one killer infectious disease in the world. This ranking of TB vs. AIDS has been debated by many, since a large number of patients with AIDS, especially those in Africa and Asia, go on to develop TB, and it is unclear to me how many of TB deaths were classified as AIDS. Regardless of how you classify it, the underlying message is very clear – there are far too many people dying with this disease.

These numbers translate to about 14,000 new infections per day. Which means that by the time I finish this presentation, about 600 persons would have acquired infection, or by the time I finish reading this slide, about 10 new infections would have occurred. 95% of these occur in the developing countries and a large number in children under the age 15.

AIDS has extorted a huge toll in terms of lives lost, since the beginning of the epidemic. In the first 20 years over 20 million persons have succumbed to this infection, most of them in the developing world, impacting those countries in manners unimaginable – both in terms of human tragedy which can never be adequately quantified and economically.

Slide courtesy of C. J. Cohen, MD.

CID 2001;33:1417 Fischl 8 th CROI 2001; Abst. 528

* Regimen adherence measurement at week 24 or last assessment while on randomized therapy

Gender, race and age were balanced across treatments PSS = Number of drugs in OB regimen to which virus was phenotypically sensitive

Transcript of "10331"

1.
Principles of HIV Therapy Simple is Better! Adeel A. Butt, MD Assistant Professor of Medicine and Infectious Diseases University of Pittsburgh Director, VAPHS HIV-ID Clinics Center for Health Equity Research and Promotion Member of Academic Research Council A non-profit organization dedicated to improving medical education and fostering research

2.
<ul><li>Objectives </li></ul><ul><li>To tell you why we should care </li></ul><ul><li>To tell you why the care is not optimal </li></ul><ul><li>To share with you how some of us feel how this may be improved </li></ul><ul><li>To describe when to initiate treatment and some initial regimens </li></ul>Principles of HIV Therapy

6.
About 14 000 new HIV infections a day in 2002 <ul><li>- More than 95% are in developing countries </li></ul><ul><li>- 2000 are in children under 15 years of age </li></ul><ul><li>- About 12 000 are in persons aged 15 to 49 years, of whom: </li></ul><ul><ul><li>almost 50% are women </li></ul></ul><ul><ul><li>about 50% are 15–24 year olds </li></ul></ul>

16.
What is the Best Initial Treatment <ul><li>What we know </li></ul><ul><ul><li>Two is better than one </li></ul></ul><ul><ul><li>Three is better than two </li></ul></ul><ul><li>What we are trying to find out </li></ul><ul><ul><li>Is four better than three???? </li></ul></ul><ul><li>IS THERE A GOLD STANDARD? </li></ul>

17.
ABC of HIV Therapy <ul><li>Here is what I am NOT going to talk about </li></ul><ul><li>All previous HIV Studies </li></ul><ul><li>Details and comparisons of all regimens </li></ul>

28.
Enfuvirtide (ENF, T-20) in Combination with an Optimized Background (OB) Regimen vs. OB Alone in Patients with Prior Experience or America and Brazil (TORO 1) Resistance to Each of the Three Classes of Approved Antiretrovirals (ARVs) in North

35.
Summary <ul><li>Chose patients to treat carefully </li></ul><ul><li>With appropriate treatment, HIV is quite controllable, like any other chronic disease </li></ul><ul><li>Missing a couple of doses a week may mean losing the game </li></ul><ul><li>Less is better, when it comes to the number of pills </li></ul>